Ortho Exam 1- Cyriax

Front 1

who was the father of orthopaedic medicine

Back 1

Cyriax (british physician)

Front 2

what are the 4 evaluation methods/concepts we ow to cyriax

Back 2

1) diagnostic method based on selective tension of structures
2) clinical interpretation of manual resisteed movement testing
3) end-feel
4) capsular patterns

Front 3

what were the 3 components of cyriax intervention approach

Back 3

1) local injections of corticosteroids
2) forceful manipulation of the spine
3) friction massage

Front 4

what is the concept of "principles of diagnosis through the selevtive testing of structures"

Back 4

to use a purely mechanical approach to the diagnossis of soft tissue lesions

Front 5

what was the goal of "principles of diagnosis through the selective testing of structures"

Back 5

to identify the soft tissue structure that is the source of the pain

Front 6

what is the method behind "principles of diagnosis through the selective testing of structures"

Back 6

reproduce pain using a combination of active, passive, and resisted movements

Front 7

what are the two groups that soft tissues can be divided into

Back 7

contractile structures and inert structures

Front 8

what are the contractile structures

Back 8

muscle, muscle tendon junction, tendon, tendon periosteal junction

Front 9

what are the inert structures

Back 9

everything that is not contractile!!!
ligaments, joint capsule, bursa, dura, nerve root, fascia

Front 10

active movemnets place stress on

Back 10

inert and contractile structures

Front 11

passive movements place stress on

Back 11

all inert structures

Front 12

resisted movements place stress on

Back 12

all contractile structures

Front 13

how must the resisted movement be tested in order for it to be used as a discriminating test

Back 13

isomentric test performed at mid-range of motion

Front 14

what type of test would detect an injury to a muscle tendon

Back 14

Pain with active and resisted movements

No pain with passive movements

Front 15

If a passive movement in painful in one direction and resisted and active movmenet is painful in the opposite direction, what type of tissue could be at fault

Back 15

all contractile: muscle, muscle tendon junction, tendon, tendon periosteal junction

Front 16

if pain with active, passive, and stretch, but no pain with resistive muscle testing what type of tissue could be at fault

Back 16

inert structures: ligaments, joint capsule, bursa, dura, nerve root, fascia

Front 17

what is the concept of "clinical interpretation of resisted movement testing"

Back 17

to use a combination of pain and weakness to determine the likely cause of muscle weakness

Front 18

what is the goal for "clinical interpretation of resisted movement testing"

Back 18

to determine the likely cause of muscle weakness

Front 19

what are the 3 steps to testing for contractile tissues

Back 19

1) resisted motion
2) palpation
3) tension

Front 20

what position should hte joint be tested during resisted motion

Back 20

near mid-range so the capsule ligaments and inert tissue are in teh relaxed position

Front 21

how strong should the examiner resist the patient during MMT

Back 21

evenly matched to the patient

Front 22

what muscles should be incorporated when doing MMT

Back 22

only the muscle being tested-- main muscle groups are tested individually

Front 23

what is the role of the examiner's hands

Back 23

one hand for resistance and the other for counter pressure (stabilization)

Front 24

why do we palpate during resisted motion testing

Back 24

to determine where the lesion lies- (applicable when the structure is accessible to the examiner)

Front 25

how do you confirm the result of the resisted movement testing

Back 25

by passively stretching the structure-

Front 26

what would a resisted movement test that is Strong and Painless, tell us

Back 26

normal contractile tissue

Front 27

what would a resisted movement test that is Strong and Painful, tell us

Back 27

minor lesion of muscle or tendon

Front 28

what would a resisted movement test that is Weak and Painless, tell us

Back 28

1) complete rupture of muscle or tendon
2) neurological disorder (paralysis due to peripheral lesion or central nervous disorder)
3) marked atrophy could be possible

Front 29

if you have a resisted movemnet test that is weak and painless, how do you determine the cause

Back 29

the patients history

Front 30

If all resisted movement tests are painful, what does this tell us

Back 30

1) psychological disorder
2) patient has a severe injury with moere than one muscle at fault
3) inert structure is likely at fault (bursistis, arthritis, fracture, severe sprain)

Front 31

If resisted movement testing is painful with repetition, what does that tell us

Back 31

vascular or local ischemic problem

Front 32

If two congruous resistive motions cause pain, what does this tell us about contractile structures

Back 32

it does not rule them out because there could be a muscle that does both of these tasks

Front 33

when would a muscle lesion be improbable with resisted motion testing

Back 33

if several resisted movements or two incompatible movemnts hurt (i.e. wrist flexoin and extension)

Front 34

what is the concept of "end-feels"

Back 34

establishing the cause of limitation of movement helps guide the intervention oriented at improving the motion

Front 35

what is the goal of "end-feels"

Back 35

to determine the cause of the limitation of motion

Front 36

what is the method of testing for "end-feels"

Back 36

perform passive ROM of the joint to its limit of range and feel the quality of resistance to the movemnt with hands

Front 37

what is the definition of "end-feel"

Back 37

the sensation imparted (quality of resistance) to the examiners hands during passive motion of a joint at the extremes of possible range

Front 38

what is a physiological end-feel

Back 38

when each joint has a characteristic normal end-feel which is dependent on the anatomy of the joint and the direction of the movement

Front 39

what is a pathological end-feel

Back 39

end-feel that occurs at another place or is of another quality than is characteristic for the joint being tested

Front 40

what would be an end feel that is sudden stop, but not hard

Back 40

cartilaginous (i.e. elbow extension)

Front 41

what would be an end feel that is soft, spongy

Back 41

soft tissue approximation (elbow flexion)... further motion is prevented by compresiosn of soft tissue

Front 42

what would be an end feel that is elastic reflex resistance with discomfort

Back 42

muscular (straight leg raise)

Front 43

what would be an end feel that is hardish arrest of movement with some give in it

Back 43

capsular (shoulder external rotation)

Front 44

what would be an end feel that is firm arrest of movement with no give or creep

Back 44

ligamentous (abduction of the extended knee)

Front 45

what are the normal endfeels

Back 45

cartilaginous, soft tissue approximation, muscular, capsular, ligamentous

Front 46

what would an expected end feel be for a muscle spasm

Back 46

sudden dramatic arrest of movemnet "vibrant twang" to prevent furtner motion and is often accompanied with pain

Front 47

what would an expected end feel be for a capsule with a pathology

Back 47

similary to normal but before the normal range is achieved

Front 48

what would be an expected bone to bone end-feel

Back 48

sudden hard stop short of normal range of motion

Front 49

what pathologies would present with a bone to bone end-feel

Back 49

myositis ossificans, osteophytes, mal-united fracture, or fracture within a joint

Front 50

what would an empty (painful) end feel be like

Back 50

soft, not limited mechanically with movement causing considerable pain- MOVEMENT STOPPED BECAUSE OF PATIENT's Pain

Front 51

what would be an expected end feel for a patient with a cartilage block, or meniscal damage

Back 51

springy rebound

Front 52

what would a soft crunchy "pannus" end feel reveal

Back 52

inflammation and thickening of synovial lining of capsule

Front 53

what you would expect the end feel to be like for ligamentous laxity

Back 53

loose, such as hypermobile or rheumatoid patients

Front 54

what is the definition of a capsular pattern

Back 54

a proportional limitation of movement due to a shortening of the whole capsule

Front 55

when a capsular pattenn is described what is the order in which they are listed

Back 55

most limited to least limited

Front 56

what is the rationale behind the "concept of capsular pattern"

Back 56

presence of capsular pattern helps establish the reason for the limitation of movement for a joint

Front 57

what joints can experience cappsular shortening

Back 57

only synovial joints that are controlled by muscle

Front 58

what is stage 1 capsular contracture

Back 58

1) synovial irritation
2) muscle guarding secondary to pain limits motion and prevents synovial capsular stretching beyond a certain point
3) gross capsulo-ligamentous contracture supervenes

Front 59

how long does eac stage in "capsular contractures" last

Back 59

hard to determine.... in general....
stage 1 6-8 weeks
stage 2 6-8 weeks
stage 3 may be permanent if cannot be stretched

Front 60

what is important to note about muscle guarding and capsular shortening

Back 60

capsular limitations begin with protection phase where muscle guarding occurs in response to pain

Front 61

what is the most common cause of a capsular pattern

Back 61

an initial injury, but inactivity can also result in a progressive decrease of range of motion and therefore capsular tightening

Front 62

what is a painful arc representative of

Back 62

whne pain only during small part of range, can be from AROM or PROM and indicates tender structure is painfully being compressed or stretched

Front 63

what does pain at one extreme of range indicate

Back 63

tender structure is being stretched or compressed

Front 64

what is excessive range of movement likely related to

Back 64

capsulo-ligamentous laxity of the joint (hypermobility)

Front 65

what does joint crepitis indicate (the two types and what they signify)

Back 65

the state of the joint gliding surfaces

Fine: slight roughening of cartilaginous articular surfaces

Course: considerable fragmentation of the articular cartilage

Front 66

where is the ONLY place you can hear/feel tendon crepitus

Back 66

in tendons with a sheath

Front 67

what does tendon crepitus indicate (the two types and what they signify)

Back 67

Fine: acute traumatic roughening of surface

Coarse: chronic inflammation or rheumatoid condition; calcification

Front 68

what are possible reasons for a "pop" reported at the time of a joint injury

Back 68

1)ruptured ligament
2) subluxation of joint
3) rupture of a tendon
4) fracture

Front 69

what does "popping" of a joint during manipulation indicate

Back 69

1) creation of a synovial bubble
2) breaking a capsular adhesion
3) loss of negative pressure within the joint

Front 70

what does snapping indicate

Back 70

1) tendon catching on bony prominence
2) impropmer mechanics or rupture of restraining structures

Front 71

what would be the two reasons for limitaiton of movement other than the capsule

Back 71

1) intraarticular derangement - due to one or more several loose bodies in the joint

2) extra-articular cause due to muscle strain, hematoma, bursitis, muscle tightness or ligamentous adhesions

Front 72

what the the clinical manifestation be for an intra-articaular derangement

Back 72

limitation of movement in 1 direction

1) movments engaging agiainst the body is painful and limited
2) movement sthat don't engage against the loose body are free and painless

Front 73

what would the clinical manifestation be for an extra-articular cause be

Back 73

movements which stretch or compress the structure are painful and limited

Front 74

how do ligamentous adhesions typically present

Back 74

slight limitation with pain in one direction but full painless range in teh opposite direction